التفاصيل البيبلوغرافية
| العنوان: |
Triple Rule-out Computed Tomographic Angiography for Chest Pain: A Diagnostic Systematic Review and Meta-Analysis. |
| المؤلفون: |
Ayaram, David, Bellolio, M. Fernanda, Murad, M. Hassan, Laack, Torrey A., Sadosty, Annie T., Erwin, Patricia J., Hollander, Judd E., Montori, Victor M., Stiell, Ian G., Hess, Erik P., Jones, Alan E. |
| المصدر: |
Academic Emergency Medicine; Sep2013, Vol. 20 Issue 9, p861-871, 11p |
| مصطلحات موضوعية: |
CHEST pain diagnosis, PULMONARY embolism, EVALUATION of diagnostic imaging, PATIENT selection, ANGIOGRAPHY, CHEST pain, CONFIDENCE intervals, DATABASES, EMERGENCY medicine, HEART function tests, LENGTH of stay in hospitals, HOSPITAL emergency services, MEDICAL care, EVALUATION of medical care, MEDICAL care costs, MEDICAL technology, META-analysis, NUCLEAR medicine, PATIENTS, QUALITY assurance, RADIATION, OPERATIVE surgery, TOMOGRAPHY, DATA analysis, CONTRAST media, DIAGNOSIS |
| الملخص (بالإنجليزية): |
Objectives The objective was to compare the image quality, diagnostic accuracy, radiation exposure, and contrast volume of 'triple rule-out' (TRO) computed tomography (CT) to other diagnostic modalities commonly used to evaluate patients with nontraumatic chest pain (dedicated coronary, pulmonary embolism [PE], and aortic dissection CT; invasive coronary angiography; and nuclear stress testing). Methods Four electronic databases were searched, along with reference lists and contacted content experts, for relevant studies from inception until October 2012. Eligible studies enrolled patients with nontraumatic chest pain, shortness of breath, suspected acute coronary syndrome (ACS), PE, or aortic dissection; used at least 64-slice CT technology; and compared TRO CT to another diagnostic modality. Results Eleven studies enrolling 3,539 patients (791 TRO and 2,748 non-TRO) were included (one randomized controlled trial and 10 observational). There was no significant difference in image quality between TRO and dedicated CT scans. TRO CT had the following pooled diagnostic accuracy estimates for coronary artery disease: sensitivity of 94.3% (95% confidence interval [CI] = 89.1% to 97.5%), specificity of 97.4% (95% CI = 96.1% to 98.4%), positive likelihood ratio (LR+) of 17.71 (95% CI = 3.92 to 79.96), and negative likelihood ratio (LR-) of 0.08 (95% CI = 0.02 to 0.27). There were insufficient numbers of patients with PE or aortic dissection to generate diagnostic accuracy estimates for these conditions. Use of TRO CT involved greater radiation exposure (mean difference [MD] = 4.84 mSv, 95% CI = 1.65 to 8.04 mSv) and contrast exposure (MD = 38.0 mL, 95% CI = 28.1 to 48.0 mL) compared to non-TRO CT patients. Conclusions Triple rule-out CT is highly accurate for detecting coronary artery disease. Given the low (<1%) prevalence of PE and aortic dissection in the included studies, and the increased radiation and contrast exposure, there are insufficient data to recommend use of TRO CT in the diagnosis of these conditions. [ABSTRACT FROM AUTHOR] |
| Abstract (Spanish): |
Resumen Angiotomografía Computarizada de Triple Descarte para el Dolor Torácico: Una Revisión Sistemática Diagnóstica y Metanálisis Objetivos Comparar la calidad de imagen, la certeza diagnóstica, la exposición a radiación y el volumen de contraste de la tomografía computarizada (TC) para 'triple descarte' (TD) con otras modalidades diagnósticas utilizadas frecuentemente para evaluar a los pacientes con dolor torácico no traumático (TC dirigida a coronarias, embolismo pulmonar (EP) y disección aórtica; angiografía coronaria invasiva; pruebas de estrés isotópicas). Metodología Se buscaron los estudios relevantes publicados hasta octubre de 2012 en cuatro bases de datos electrónicas, en las listas de la bibliografía y en los expertos de contenido contactados. Los estudios elegibles incluyeron pacientes con dolor torácico no traumático, disnea, sospecha de síndrome coronario agudo, EP o disección aórtica; utilizaron TC con tecnología de al menos 64 cortes; y compararon la TC TD con otra modalidad diagnóstica. Resultados Se incluyeron once estudios (uno aleatorizado y 10 observacionales) con 3.599 pacientes (791 TD y 2.748 no TD). No hubo diferencias significativas en la calidad de la imagen entre TC TD y los dirigidos. La TC TD tuvo las siguientes estimaciones de certeza diagnóstica para la enfermedad de las arterias coronarias: sensibilidad 94,3% (intervalo de confianza [IC] 95% = 89,1% a 97,5%), especificidad 97,4% (IC 95% = 96,1% a 98,4%), razón de probabilidad positiva 17,71 (IC 95% = 3,92 a 79,96), y razón de probabilidad negativa 0,08 (IC 95% = 0,02 a 0,27). No hay suficiente número de pacientes con EP o disección aórtica para generar estimaciones de certeza diagnóstica para estas enfermedades. La utilización de la TC TD supuso una mayor exposición a la radiación (diferencia de la media [DM] 4,84 mSv, IC 95% = 1,65 a 8.04 mSv) y al contraste (DM 38,0 mL, IC 95% = 28,1 a 48,0 mL) en comparación con los pacientes con una TC no TD. Conclusiones La TC TD es altamente certera para detectar la enfermedad coronaria. Dada la baja prevalencia (<1%) de EP y de disección aórtica en los estudios incluidos, y el incremento de radiación y exposición a contraste, no hay suficientes datos para recomendar el uso de TC TD en el diagnóstico de estas dos enfermedades. [ABSTRACT FROM AUTHOR] |
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